This government document is issued by Board of Pilot Commissioners For the Bays of San Francisco, San Pablo, and Suisun for use in California
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https://www.google.com/url?client=internal-element-cse&cx=001779225245372747843:5bwscbqzsza&q=https://bopc.ca.gov/wp-content/uploads/sites/41/2020/09/12B-05-2020-Medical-Assessment-Forms-R.pdf&sa=U&ved=2ahUKEwiestPa_4fyAhUI_yoKHVEOD9QQFjAAegQIBRAC&usg=AOvVaw1Jkt1UNEjaZ1corjLlEo4e